TY - JOUR
T1 - Coronary risk prediction for those with and without diabetes
AU - Woodward, Mark
N1 - Funding Information:
Writing committee: M. Woodward, F. Barzi, T.H. Lam, K. Jamrozik, H. Ueshima, A. Patel. Executive committee: D.F. Gu, T.H. Lam, C.M.M. Lawes, S.W. MacMahon, W.H. Pan, A. Rodgers, I. Suh, H. Ueshima, M. Woodward. Participating studies and principal collaborators: Aito Town : A. Okayama, H. Ueshima; H. Maegawa; Akabane *: N. Aoki, M. Nakamura, N. Kubo, T. Yamada; Anzhen02 *: Z.S. Wu; Anzhen : C.H. Yao, Z.S. Wu; Beijing Aging : Z. Tang; Beijing Steelworkers : L.S. Liu, J.X. Xie; Blood Donors' Health : R. Norton, S. Ameratunga, S. MacMahon, G. Whitlock; Busselton *: M.W. Knuiman; Canberra-Queanbeyan : H. Christensen; Capital Iron and Steel Company (CISC) *: X.G. Wu; CISCH : J. Zhou, X.H. Yu; Civil Service Workers : A. Tamakoshi; CVDFACTS *: W.H. Pan; East Beijing *: Z.L. Wu, L.Q. Chen, G.L. Shan; EGAT *: P. Sritara; Fangshan *: D.F. Gu, X.F. Duan; Fletcher Challenge *: S. MacMahon, R. Norton, G. Whitlock, R. Jackson; Guangzhou : Y.H. Li; Guangzhou Occupational *: T.H. Lam, C.Q. Jiang; Hisayama : M. Fujishima, Y. Kiyohara, H. Iwamoto; Hong Kong *: J. Woo, S.C. Ho; Huashan* : Z. Hong, M.S. Huang, B. Zhou; Kinmen : J.L. Fuh; KMIC *: I. Suh, S.H. Jee, I.S. Kim; Konan* : H. Ueshima, Y. Kita, S.R. Choudhury; Longitudinal Study of Aging *: G Andrews; Melbourne *: G. Giles; Miyama *: T Hashimoto, K Sakata; National Heart Foundation *: T.A. Welborn; Newcastle *: A. Dobson; Ohasama *: Y. Imai, T. Ohkubo, A. Hozawa; Perth *: K. Jamrozik, M. Hobbs; Saitama *: K. Nakachi; Seven Cities *: X.H. Fang, S.C. Li, Q.D. Yang; Shanghai Factory Workers : Z.M. Chen; Shibata *: H. Tanaka; Shigaraki Town *: Y. Kita, A. Nozaki, H. Ueshima; Shirakawa *: H. Horibe, Y. Matsutani, M. Kagaya; Singapore Heart : K. Hughes, J. Lee; Singapore NHS92 *: D. Heng, S.K. Chew; Six Cohorts *: B.F. Zhou, H.Y. Zhang; Tanno/Soubetsu *: K. Shimamoto, S. Saitoh; Tianjin : Z.Z. Li, H.Y. Zhang; Western Australia AAA Screenees *: P. Norman, K. Jamrozik; Xi'an : Y. He, T.H. Lam; Yunnan *: S.X. Yao. *Studies providing data used in this paper.
PY - 2006/2
Y1 - 2006/2
N2 - Coronary risk prediction ‘engines’ are now in common use, and their worth is well proven. There remains the question of how to deal with a prior diagnosis of diabetes. An individual participant meta-analysis of 33 cohort studies involving 364 566 subjects. Fatal coronary hazard ratios for age, smoking, systolic blood pressure and cholesterol, were computed from Cox models, comparing those with and without diabetes. Three risk prediction equations were compared: a ‘stepped model’, which included the risk factors and diabetes status; an ‘interaction model’, which included interactions between diabetes and the risk factors; and a ‘fixed model’, which fixed the 10-year rate of coronary death amongst those with diabetes to be 7%. These were compared through the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow statistics. The hazard ratio for age was greater for those without diabetes than those with, for men (P=0.005) and women (P=0.02); for men only, systolic blood pressure showed a similar differential (P=0.011). Nevertheless, AUCs were only 0.001 different for the stepped and interaction models for each sex. The AUC for the fixed model was lower and, unlike the other two, showed significant lack of fit for both sexes (P< 0.001). There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk. Diabetes status might, instead, be used as a risk variable in an overall population equation.
AB - Coronary risk prediction ‘engines’ are now in common use, and their worth is well proven. There remains the question of how to deal with a prior diagnosis of diabetes. An individual participant meta-analysis of 33 cohort studies involving 364 566 subjects. Fatal coronary hazard ratios for age, smoking, systolic blood pressure and cholesterol, were computed from Cox models, comparing those with and without diabetes. Three risk prediction equations were compared: a ‘stepped model’, which included the risk factors and diabetes status; an ‘interaction model’, which included interactions between diabetes and the risk factors; and a ‘fixed model’, which fixed the 10-year rate of coronary death amongst those with diabetes to be 7%. These were compared through the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow statistics. The hazard ratio for age was greater for those without diabetes than those with, for men (P=0.005) and women (P=0.02); for men only, systolic blood pressure showed a similar differential (P=0.011). Nevertheless, AUCs were only 0.001 different for the stepped and interaction models for each sex. The AUC for the fixed model was lower and, unlike the other two, showed significant lack of fit for both sexes (P< 0.001). There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk. Diabetes status might, instead, be used as a risk variable in an overall population equation.
KW - blood pressure
KW - cholesterol
KW - coronary heart disease
KW - diabetes
KW - risk
KW - smoking
UR - http://www.scopus.com/inward/record.url?scp=33646119404&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33646119404&partnerID=8YFLogxK
U2 - 10.1097/01.hjr.0000186619.68110.95
DO - 10.1097/01.hjr.0000186619.68110.95
M3 - Article
C2 - 16449861
AN - SCOPUS:33646119404
SN - 2047-4873
VL - 13
SP - 30
EP - 36
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 1
ER -